Study Finds 1 in 6 Experience Antidepressant Withdrawal Symptoms

If you’ve ever considered taking an antidepressant, you know it's common to have a lot of questions. Will you be able to tell if it’s working? And if it does work, how long will you need to take it? Many people worry about antidepressant side effects. Others, who’ve heard stories of antidepressant withdrawal from friends or family, worry about the effects of stopping the medication.

A new study might offer a bit of reassurance to this last group. Researchers found that antidepressant withdrawal, or antidepressant discontinuation syndrome, isn’t as common as once believed. 

In the new meta-analysis, researchers reviewed studies that included more than 22,000 people taking either an antidepressant or a placebo. They found that only about 15 percent of patients (about 1 in 6) reported unpleasant symptoms after discontinuing these medications. Previous estimates had put that number closer to 50 percent.

Among those who did experience symptoms, they typically included dizziness, headache, nausea, insomnia, and irritability. 

The likelihood that someone would experience discontinuation symptoms varied depending on the kind of antidepressant they took. Of the medications studied, those with the highest rates of discontinuation symptoms included imipramine (Tofranil), desvenlafaxine (Pristiq, Khedezla), and venlafaxine (Effexor, others). These drugs belong to a class of medications called serotonin-norepinephrine reuptake inhibitors (SNRIs). 

According to the study, the antidepressants with the lowest likelihood of discontinuation symptoms include fluoxetine (Prozac) and sertraline (Zoloft). Fluoxetine and sertraline are both selective serotonin reuptake inhibitors (SSRIs).

A Word from the Experts

It’s important to note that when we talk about “antidepressant withdrawal,” we’re not implying that people get addicted to antidepressants. Dr. Daniel Z. Lieberman, senior vice president of mental health at Hims & Hers, explains that there’s a difference between discontinuation symptoms and withdrawal symptoms. 

“The essence of addiction that you see in withdrawal is an overpowering desire to take the drug again — and it’s not just to make the withdrawal symptoms go away,” says Dr. Lieberman, who serves as a clinical professor of psychiatry and behavioral sciences at George Washington University. “With antidepressant discontinuation, you get symptoms, and they can be very uncomfortable, they can be quite severe, but there's no craving.” 

So, what actually causes discontinuation symptoms? It has to do with the time it takes for your brain to get used to living without the medication. 

Look at when someone first starts taking an SSRI, says Dr. Lieberman. “The first few days, the first few weeks, you don't feel any effects. It's only two, four, maybe even eight weeks later that you're feeling better.”

“It’s the body’s adaptation to the drug,” says Dr. Lieberman, “that’s what leads to improvement.” 

Discontinuation syndrome happens when this process occurs in reverse. 

It’s a shock to the system, says Dr. Lieberman. “When an adapted body or an adapted brain no longer has the thing it’s adapted to.” 

What to Watch For

Discontinuation symptoms, if they do occur, tend to appear about 1 to 10 days after stopping the medication. Symptoms can range from mild to severe. This can be problematic, especially when it delays the process of switching to a different antidepressant.

According to the new study, only about 3 percent of people report severe symptoms after discontinuing antidepressants. But, some critics have pointed to the limitations of the research, noting that it may not fully account for the experiences of long-term users. The average length of time that patients in the study were taking antidepressants was 25 weeks. 

As two London researchers recently argued, long-term antidepressant use is increasingly common, and these are the folks who may be most at risk of experiencing symptoms upon discontinuation. In the U.K., more than a quarter of all patients on antidepressants have been taking them for at least five years. In the U.S., more than 60 percent of people taking an antidepressant have been taking it for two years or longer. 

Debate about the terms, severity, and incidence of antidepressant withdrawal isn’t new — the London researchers echo earlier work, arguing that many clinicians underestimate the likelihood and intensity of discontinuation symptoms.

What You Can Do

Most clinicians and researchers agree that tapering is the best way to reduce your risk of discontinuation symptoms. Medication tapering is the process of gradually reducing a medication so the body has time to adapt. This process should always be done with the guidance of a medical professional. 

Unfortunately, antidepressant tapering isn’t always as simple as it should be. It can be difficult when the medication is only available in a limited range of doses, and patients have to cut their pills in half or in quarters. 

In many cases, says Dr. Lieberman, “The slower you taper, the more mild the symptoms are going to be.”  

But this may not be necessary for everyone, he explains. According to Dr. Lieberman, the most important part of any mental health treatment plan is that it be individualized.

This is one area where compounding pharmacies, like the one Hims & Hers works with, may be able to help. With personalized mental health care, clinicians are able to offer solutions that you can’t find at mainstream retail pharmacies.